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Weight-loss Surgery proven most successful against diabetes

| Date Posted: 6/4/2012 | Author: Mandy McCue

Obesity and diabetes are our nation’s twin epidemics. There are over 100 million American adults that are overweight or obese, and that’s enough people to wrap around the world. Moreover, about 20 million American adults have diabetes, of which 80 percent are also obese.

Two noteworthy clinical trials were conducted within the last year. One, in Italy, and one in the United States, both showed a significant improvement in the blood sugar control and significantly greater weight loss in obese patients with Type 2 diabetes who underwent bariatric surgery. Both studies examined patients who had undergone one of three bariatric surgery procedures: biliopancreatic diversion, Roux-en-Y gastric bypass or Sleeve Gastrectomy and compared them to patients using conventional treatment for diabetes such as medication combined with diet and exercise.

The Researchers from the University of Rome in Italy conducted a study that included 60 morbidly obese patients with Type 2 diabetes. The 60 patients were divided into three groups; conventional diabetic care including medications; the second group underwent Roux-en-Y bypass; and the third had a biliopancreatic diversion.

Within two years after the surgery, 95 percent of those in the biliopancreatic diversion group experienced a remission of their diabetes, as did 75 percent of those in the Roux-en-Y gastric bypass group. Though blood sugar control improved in the group using diabetes medication, there was no evidence of remission in those test subjects.

The U.S. study examined 150 people, 50 had Sleeve Gastrectomy, 50 had Roux-en-Y gastric bypass, and 50 people received intensive medication, monitoring, and diet and exercise counseling.

After one year, 78 percent of those who had gastric bypass and 51 percent of those who had Sleeve Gastrectomy were off of all diabetic medications. The proportion of subjects taking lipid-lowering medications dropped from 86 percent to 27 percent among those who had gastric bypass and was cut in half among those who had Sleeve Gastrectomy.

“’The most effective treatment right now for diabetes is surgery’- you can use that as a sentence,” said Dr. Daniel Bessesen, chief of endocrinology at the University of Colorado Hospital in Denver. It is far too soon to say that this could be a ‘cure all’ for diabetes because long-term effects are still unknown, but this is a positive step in the right direction. (Source: LA times; Weight-loss surgery effective against diabetes, studies show)

Problems

Insurance Companies: Insurance companies impose their own requirements before they will cover bariatric surgery, such as consultations with dieticians or pre-surgery weight loss target goals the patient must meet to demonstrate that they can follow a diet and exercise plan, which is a key for success post-surgery weight loss.

Patient Safety: Currently 220,000 people undergo bariatric surgery a year in the U.S. and that number has been growing with the increasing percentage of obesity; patient safety has been a growing concern with the explosion of facilities providing bariatric surgeries. There are over 110,000 hospitals in the country that perform bariatric surgeries. (Source: JAMA; Characteristics of hospitals performing bariatric surgery) While the complications for bariatric surgery in the U.S. are relatively low, estimated at approximately 4 out of 100, according to HealthGrades, which produced a comprehensive look at bariatric surgery and its costs and quality, of the 468 hospitals that it evaluated, 107 ranked “best performers” and 100 were rated poor. (Source: LA Times; Questions remain about weight-loss surgery for diabetes)

Since it is unrealistic that every diabetic can receive surgery, it is important for primary care physicians, endocrinologists and surgeons to work together to decide which Type 2 diabetes patients would benefit most from the surgeries. It is also important for primary care physicians to understand the needs of a bariatric surgery patient. Special guidance is needed to maintain their bone health and nutritional needs, since critical vitamins and minerals will not be readily absorbed due to the surgery.

FirstHealth Moore Regional Hospital in partnership with Pinehurst Surgical also offers comprehensive care when it comes to weight loss and weight-loss surgery. Our comprehensive Bariatric Surgical Program serves patients in the Pinehurst, Sanford, Raeford, Laurinburg, Lumberton, Troy and Rockingham regions of North Carolina and beyond. Call (800) 213-3284 with questions or for more information.